Goals and Effects of “Iranian Pay for Performance” Program for Non-Medical Workforce in Teaching Hospitals: Qualitative Study

The design of each pay mechanism, theoretically, affects the behavior of providers and creates different responses. This study is a survey of the new Iranian performance-based payment method for the hospital staff (Recommendation 2014) and its possible effects on the behavior of staff and hospitals.

A qualitative study was conducted at two national and provincial levels using a documentary review, taking notes in meetings, and individual interviews (13 people at the ministry, university, and hospital levels). Content analysis was performed using MAXQDA V. 10 software, and the extraction of codes was thematic.

Aligning staff individual objectives with organizational performance; decentralization in employee administration; more predictability of staff costs; motivating to take care of more patients; reducing incentives for induced demand and insurance deductions; effect of three groups of individual, work-related, and functional factors on individual pay and gathering accurate information about the amount paid to employees in the country are the goals and potential positive effects of the program. Complexity, reciprocity of the program, postponement of payment to employees, and lack of transparency in the insurance deductions of each department were program problems.

Potentially, this program provides the right tools to meet the desired goals, however, it depends on the capacity of the executive directors. The postponement of employee payments is the biggest threat to the effects of this program.